Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal

Abstract

Arthroscopic surgery of the posterior compartment of the knee is difficult when only two anterior portals are used for access because of the inaccessibility of the back of the knee. Since its introduction, the posterior transseptal portal has been widely employed to access lesions in the posterior compartment. However, special care should be taken to avoid neurovascular injuries around the posteromedial, posterolateral, and transseptal portals. Most importantly, popliteal vessel injury should be avoided when creating and using the transseptal portal during surgery. Purpose of the present study is to describe how to avoid the neurovascular injuries during establishing the posterior three portals and to introduce our safer technique to create the transseptal portal. To date, we have performed arthroscopic surgeries via the transseptal portal in the posterior compartments of 161 knees and have not encountered nerve or vascular injury. In our procedure, the posterior septum is perforated with a 1.5-3.0-mm Kirschner wire that is protected by a sheath inserted from the posterolateral portal and monitored from the posteromedial portal to avoid popliteal vessel injury.

Keywords: Arthroscopic surgery, Knee, Posterolateral portal, Posteromedial portal, Transseptal portal

Core tip: Arthroscopic surgery in posterior compartment of the knee via the transseptal portal is less invasive to the patient compared to open surgery for access to the back of the knee. However, special care should be taken to avoid neurovascular injury when creating the three posterior portals. We have not encountered neurovascular injury with our procedure for creating a posterior transseptal portal in 161 treated knees, and conclude that it is safe and reliable.